Mixed reality (MR) is the combination of real and virtual worlds to create new environments and visualizations, where physical entities and digital objects coexist and can interact in real time, to be used as an analogy to real objects. In 1994, Paul and Fumio [
5] proposed a definition of the reality–virtuality continuum, and the mixed reality is located at any point between the extreme values of the virtual continuum (VC). The two sides of the virtual continuum are the real environment and the virtual environment. The technology close to the real environment is augmented reality (AR), which uses the perceptual information created by the computer to increase the experience of real objects and additional information. On the other side of the spectrum is augmented virtuality (AV), which is a technology that adds physical elements to the experience of a virtual world. The unique feature of mixed reality is the fusion of the two at the same time. By superimposing reality and virtualization, users can interact with virtual objects in a real environment, shattering the basic concept of reality and imagination. As early as the 1930s, science fiction writers and inventors had already dreamed of creating an environment where people could escape from reality through art and machines. Many scientists have been evaluating the feasibility of virtual, augmented, and mixed realities for a long time, but the technology was not available at the time; it was only in the last decade that the technology became available.
In 2009, Microsoft announced a sensor called Project Natal [
6], and in 2010 announced the official name of Project Natal as Kinect, which was applied to the peripheral devices of Xbox One and Xbox 360 consoles, and was considered a pioneering device to popularize the user’s physical control and changed the way of playing games at that time. In 2013, Google glass was launched [
7], and since then, a large number of wearable products have emerged, including smart glasses, which have been left out of the market, and head-mounted display (HMD) products have become the stars of tomorrow. With the launch of smart glasses, information technology has taken a giant leap forward, and the biggest change is that the scene seen by the eyes can be calculated and recognized at any time, and the result will be presented to the user. The market for smart glasses is currently booming, and with many related applications coming out, smart glasses will probably become one of the most widely used products in the field of wearable devices in the next few years.
In 2016, Microsoft HoloLens was launched [
8], which continued the Kinect’s body tracking technology and presented it as a head-mounted display, followed by Microsoft’s second-generation HoloLens 2 in 2019, highlighting three main improvements: immersion, ergonomics, and business friendliness. HoloLens 2 will be used in this study. Today’s mixed reality applications are mainly used with head-mounted displays (HMD), in which users can see virtual objects and appear to be in a real environment, similar to AR, but with the “immersion” and “virtual interaction” elements of VR. The combination of reality, augmented reality, and virtual reality technologies presents a mix of real and virtual worlds that is indistinguishable. In other words, MR not only retains the immersive and interactive nature of VR but also emphasizes the interactive elements of virtual objects in the real world more than AR. Wu and Vu [
3,
9] developed an aircraft maintenance virtual reality (AMVR) system for training students in the aviation education and evaluated the effectiveness of the system.
Guhl [
10] presents a concept and architecture for interacting and programming robotic systems, especially industrial robots, using mobile devices such as HoloLens. The robots and mobile devices are connected through so-called agents and communicate using protocol buffers on top of TCP/IP connections. Various mobile devices running on different operating systems and hardware performance levels can be supported using sophisticated software components such as game engines. Sirilak et al. [
11] found the use of HoloLens in critical care to be very beneficial in providing care and preventing or reducing morbidity and mortality, but HoloLens technology requires adequate prior training for users to implement, and users are not at all accustomed to the technology and are likely to continue to rely on the telephone for consultation, or to use applications such as Skype and LINE. They are likely to continue to rely on phone calls for consultation or use various applications such as Skype and LINE for video calls. On the other hand, using technology as an educational and training tool will go a long way toward overcoming the staffing shortage that is currently occurring. It can also be used to improve the efficiency of patient clinical teaching for physician teams and ICU nurses, increasing their experience and opportunities to learn alongside critical care medical professionals. Asgary et al. [
12] have created an MR application called HoloVulcano that visualizes the various phenomena that can occur in a volcano for emergency management training, public education, and awareness. The application can provide a new way to visualize volcanic eruptions and volcanic emergencies, enhance learning and training, and improve preparedness and understanding of the risks. Gao et al. [
13] have built a virtual museum with Vuforia, which not only scans and images the camera using mixed reality devices but also scans images to present models using augmented reality. By breaking the boundary between augmented reality and mixed reality, the two can play to their respective strengths and enhance user immersion and substitution. In cooperation with Taiwan Li-Wei Computer Machinery Company, Lai [
14] designed the system for a five-axis machining machine called “V-40iT”, using the section “Troubleshooting blade jam” in its troubleshooting manual. After the completion of the system, we visited the company to conduct interviews and surveys. According to the results, the troubleshooting assistance system should be able to solve the shortcomings of traditional troubleshooting and increase the willingness of personnel to use the system again. Ghazali et al. [
15] supplemented the learning process of desalination plant technology concepts with multimedia technologies such as HoloLens. The team built a working prototype of an MR game, as shown in the methodology section. The prototype includes a map scene that allows users to navigate the game, three tutorials that familiarize users with the basic gesture functions of HoloLens, and two mini-games that allow students to understand the desalination plant process. This project brought new learning experiences to the research team and analyzed developments in the field of education combined with mixed reality technologies. The team also expects that their research will create more directions for self-learning and educational purposes. Harper et al. [
16] used the Microsoft HoloLens camera to scan QR codes and manipulate virtual scribe markers with gestures to perform a stone chipping simulation for training college-level stonemasons in stone grinding. By using virtual stones, a physical grinder can be used as a tangible interface without the associated safety risks. The main challenge of this investigation was the use of tangible objects as an interface to the virtual learning environment, which was achieved through low-latency, real-time tracking, allowing for trusted interaction with virtual content. The application was designed and developed in conjunction with several further education colleges in Scotland and has been evaluated by teachers and learners. Danie et al. [
17] created an epidural analgesia simulator to increase the training space through the use of dummies, HoloLens, digital guidance, 3D audio feedback, and voice commands. The purpose of this study is to explore the potential of optical fluoroscopic augmented reality technology (OST-AR) for epidural anesthesia training. To do so, the system places relevant 3D anatomical teaching messages and visual guides on and around the dummy, supplemented by audio feedback to guide the teaching process.